This position is responsible for the support of the Amida Care Pharmacists in monitoring drug utilization trends to deliver positive results for our members. Serves as link between Amida Care members, providers; pharmacies and Pharmacy Benefit Manager (PBM) for pharmacy benefit related issues and initiatives. Participates in building programs for our members that promote health and encourage appropriate medication use in a customer friendly environment.
Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.
• Provide pharmacy technical and analytical support to other Amida Care departments in support of providing all members and providers with accurate, timely and customer friendly information.
• Provide accurate and timely pharmacy reports from the Pharmacy information systems (e.g. PBM data tool) and perform initial analysis of pharmacy reports for interested parties.
• Serve as liaison between PBM and Amida Care Members Services to improve pharmacy services Amida Care offers; i.e., member eligibility, Restricted Recipient Program, utilization management inquires, pharmacy inquiries, etc.
• Coordinate Amida Care Pharmacy Utilization Programs (Medication Authorizations, Appeals and Complaints), including but not limited to information gathering, data entry, request routine, obtaining laboratory data, request documentation, verbal and written communication of results, status updates.
• Perform customer service quality control and Service Level Agreement (SLA) compliance reviews of the PBM including quality control of PBM member calls and prior approval letters, as well as, reviewing PBM customer service statistics. Report aberrations and SLA failures to appropriate management staff.
• Provide primary support for Pharmacy related Fraud, Waste and Abuse. This includes application of pharmacy policies and procedures on a case-by-case basis to assist with adherence to the Prescription Monitoring Program (PMP) and the Restricted Recipient Program (RRP). In charge of setting up and facilitating oversight meetings with PBM.
• Communicate with pharmacists, nurses, physicians, and other health care providers and their staffs regarding medication management programs and initiatives with appropriate and thorough follow up.
• Support organization quality initiatives (QARR, HEDIS, STARS) through reporting and member/provider/pharmacy outreach as required to continuously improve the pharmaceutical and medical care provided to Amida Care Members.
• High School diploma or General Educational Development (GED). Bachelor’s degree preferred.
• One (1) to two (2) years’ experience working with target population, specifically HIV/Specialty Pharmacy, preferred.
• Certification as a Pharmacy Technician (CPhT).
• One (1) to two (2) years’ Retail Pharmacy Experience.
• Strong knowledge of Microsoft Office (Word and Excel).
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.Position Description »